Strategic Framework on Multiple Chronic Conditions Will Influence NP Practice

Abstract

PhD, NP T he Affordable Care Act, with its emphasis on disease prevention, brings new attention to how US healthcare is provided and focuses attention on nurse practitioners (NPs) as an important component of the healthcare system. This new focus has stressed the importance of learning how to care for our patients in a better way, particularly those who have chronic illnesses. A close examination of US healthcare statistics reveals that more than a quarter of all Americans—and 2 of 3 older Americans—have multiple chronic conditions. Treatment for individuals with chronic illnesses accounts for 66% of the country’s healthcare budget, whether it is public or privately funded. These numbers of individuals with chronic illnesses are expected to rise as the number of older Americans increases. An analysis of current healthcare shows that the system is largely designed to treat one disease or condition at a time. This is an antiquated treatment format, often resulting from the high utilization of specialists who focus on one disease entity and where coordination of overall care is often missing or fragmented. As the number of chronic conditions that a person has increases, so do the risks of drug and physiologic complications, including adverse drug events, duplication or gaps in services, unnecessary hospitalizations, and confusion caused by conflicting medical advice. The US Health and Human Services recently issued the report “Strategic Framework on Multiple Chronic Conditions.” This report is a strong indictment of the current healthcare system and a call for change. (See http://www.hhs.gov/news/press/2010pres/12/20101214a. html for more information about this report.) A press release from HHS indicates the report outlines a new strategic framework to be coordinated by the agency. The report claims the new framework is designed to reduce the risks of complications and improve the overall health status of individuals with multiple chronic conditions. The framework is meant to provide more information and better tools to help health professionals and patients learn how to better coordinate and manage care. The framework also aims to facilitate research to improve oversight and care of patients. As such, all healthcare providers should learn about the new framework and how they will fit into the impending system. The report emphasizes, “The management of multiple chronic conditions has major cost implications for both the country and individuals. Increased spending on chronic diseases is a key factor driving the overall growth in spending in the Medicare program.” Especially during these times of fiscal constraint, individuals with multiple chronic conditions face increased out-of-pocket costs for their care, prescriptions, and support services. The integration and coordination of care for this Medicare population is foundational if better care, lower costs, greater efficiency, and quality are to be realized. NPs need to be adequately prepared if they are to participate fully in the opportunities to keep chronic conditions from occurring in the first place and to improve the quality of life for patients who have them. Nurse practitioner educational programs must be responsive to making changes in how to care for patients with chronic diseases. In this effort, JNP is timely in our focus throughout 2011 on the management of chronic diseases.